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HomeMy WebLinkAboutBuilding Permit # 8/22/2016 Sy0FR?TF1 BUILDING PERMIT TOWN OF NORTH ANDOVER 3=o�sLEor =6"x'0 APPLICATION FOR PLAN EXAMINATION Permit No#: Data Received ��SsgcHu����� Date Issued: 422a-ORTANT: Applicant must complete all items on this page LOCATION Z6 �0� �-Z Print% 6-C ' PROPERTY OWNER l �f �� Print 100 Year Structure W5e 90--11 MAP PARCEL: L) ZONING DISTRICT: Historic District no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No, of units: ❑ Commercial Repair, replacement ❑Assessory Bldg El Qthers: ❑ Demolition ❑ Other ❑�Septtc ❑Well f� Floodplain ❑Wetlands 1�, Watershed District, ❑:-1lalaterlSewer, �.:�, � � .�� .y, DESCRIPTION OF WORK TO BE PERFORMED: j6A.d reLAC/6C 0()/1 1v C1!7 lav S�e c�I � Identification- Please Type or Print Clearly OWNER: Name: tS fc l +? Phone: 6 7J'() Address C ��� Av ndo cv Contractor Name: Phone: 9 7 Z Email: c' Ad( 4 Ak. e 0sb aj Supervisor's Construction License: -i Exp. Date: % -Ob Home Improvement License: 6 X, Exp. Date: �7 ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cosi:: $ & ka. e)o FEE: $ Check No.: Receipt No, NOTE: Persons contracting with unregistered contractors do not have accent glar ,NH ORT ,9 Town of 2 6 ndover 0 1 A a RAK� h ver, Mass, COC KIC Ml-CR 4 �.q RRTfo IF aS u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... .. . :�1 -Det .t.. ............... BUILDING INSPECTOR has permission to erect .......................... buildings on ... it..... R ....%&."410 ,.......... Foundation . Rough to be occupied as ..... . . ..... ......�.. nd; .., �Ca" � ..... ......, Chimney provided that the person accepti g this permit shall in eve &peci]1-k?conrm to the terms of thea lica onrypp final on file in this office, and to the provisions of the Codes and By-Laws rely" to the Ins ct'Lon,Alteration and Construction of Buildings in the Town of North Andover. K PLUMBING,INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN fi MONTHS ELECTRICAL INSPECTOR �+ . UNLESS S I Rough i: Service . ... ...... .... �IiN�SCTO . Final BUILDIN GAS INSPECTOR ccupanev PermitRequired equired t® Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DAVID CASTRICONE, PIES. g, 6 •�4 CASTRICONE ROOFING & SICCING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231R SUTTON STREET UNIT 3A, NO,ANDOVER, MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7374 Uwc the owncr(s)of the premises rtlentloned below,hereby contract with and authorize you as contractor,to fin-nish all necessary materials,labor and worknxutship,,to install,construct and place the improvements according to the following specifications,terns and conditions,on premisq;yelow de cribed; Owner's Name........ I.ts.... �r�,. ....�, ... .� ,.. ..�./.....................................Tei otre lf......�-/.LJ...�../../... .�..1-.5.�.... Job Address...... „�).T............................City... L7d-...r ��E�t1.. t? ........Stale.. ......... ,Specifrcutiars: ...................................................... ....,.....r....................,.................................. ...-. ...-...... .ca . (s.kL2.............................. U L .......... ......I ............ .............. .............. .......................... :.-. f?...J......5. z.1.. J.. ................................ ............. ... ... ...W .. .J...1/.. �. ..,.�.,.l..at..k)....... ... ...�,..,-r`�k....�................... ..................... .,...........................,. f I.. l ��.�. . .... ..,. . z�j .....-c..... ... ... . , .t .. .......................... J ” j ..�: /....LS.f iE........t ?,71 � Cr.II. I`'s~t..�f (`C al..... .�C� C>fI.•\F ...................................................................................................................................................................................................................... .............................................................................................................................................................................................. .................... ......... ............................ _............... .... Five year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as spcci lett�iy ri a'rin7a7tATe 'the contractor a�es to perl'orm the work d ish the materials specified above for the SUI i of$..... �.i . .. payabi .... � � ....,..on...45�i . .�........ "_;77— Payable.............................on..,............................... Balance payable on completion of job Owner or Owners lire not responsible for property Damage or Uahitily while job is in operation. Contractor is not responsible for any damage to the interior of propcny,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above (i.e.objects coming loose IFom walls,crumbling plaster,exposed nails,dust in altie or other living spaces). Items in atlic may aced to he covered by honicuwner.AI l materials are property of contractor. Any dumpster placed by contractor is for his use Only,Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance;with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shAl be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shalt be incurred in enforcing the terns and conditions of the cuntrncl and/or a,ty lien in connection herewith.Property may be subject to mechanic's lien if unpaid.It is further agreed that this contract may Ise assigned by contractor,and also that the obligations herttwf shnll bind and apply to their heirs,successors or estates ofthe paniell The undersigned warianl(s)that he is(they we)the owners(s)of the above mentioned premises and that lead title thereto stands ofretxwrd in his(their) natnes(s).There arc no representations,guaranties or war(antics,cxccp€such as may be herein incorpurnted,if arty,nor uny aWemcnls collateral hereto,nor is the contract dependent upon or subject to any conditions not herein slated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Honte Improvement Con(ractors shill]be registered and any inquiries about a contractor or subcontractor relating to a registration should be diredted to 114 Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700, Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered contractors is excluded from the Guaranty Fluid provisions of MGL c. 142A. Approximate starting date of work................................................ Completion date.............................................-..........I .Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the Undersigned that the foregoing provisions have beets read and the contell is Ihere af understood and that no representation or agreen wit t not herein contained shall be binding upon the parties and that all of the agreements and unders(andings of said parties are contained herein. DO NOT SIGN THIS CONT AC1 IF THERE ARE ANY BLANK SPACES Phis contract may be cancelled,without penalty or obligation,within three business days of the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone hoofing&Siding frit,,731 R Sutton 5t.,No,Alulil' MA 101845, JN WITNESS WHEREOF,the parties have hereunto sighed their names this...4.x. !.day of,.1 1 Signed....i.••Jt�&�..... ............ Owner Signed............................................................................. owner. David Castricone,President r' i✓hsa�t The Commonwealth of Massachusetts Department of Industrial Accidents i a 1 Congress Street, Suite 100 k Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aplrlicant Information Please Print Le0b1y Name (Business/Organization/Individual): .t': C_/\,Sli l Co d C 1 3? C.. i ML Address: -A b) (Z -�5 T. l)c\%T 6 A City/State/Zip: �A4• A N Doy eA JV/q Phone #: q l� •6 93-3 YoZ© Are you an employer?Check the appropriate box: Type of project(required): XI am a employer with employees(full and/or part-time).* 7. n New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, 0 Remodeling any capacity.INo workers'comp.insurance required.] 9. El Demolition 3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 [] Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.E]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.' 13RoOf repairs 5.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: f'ZA N I re N C tri Policy#or Self-ins,Lic. LQ .. �_ 7 Expiration Date: r �, �; Job Site Address: 06JV- 1 City/State/Zip: /0 'Alelc✓e /"1,4 odxf Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or orae-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: _J C ` Date: Phone#: 9`7 L SS 3 ..3 4 du Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: A� CERTIFICATE OF LIABILITY INSURANCE gA28i2a1NY I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SeleCt Dept.. Eastern Insurance Group LLC PHONE (800)3337234 X66807 FAX Not,(781)586-8244 233 West Central St E-MAIL,sLselectworklaeasterninsurance.com INSU RER(SJ AFFORDING COVERAGE NAIL 0 Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc. INSURER C:Grani te State Insurance Co. 231 Rear Sutton Street, Unit 311 INSURER D: INSURER E North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBER:CL159964794 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. 1NSR TYPE OF INSURANCE ❑ L L POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDNYYY MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERC#AL GENERAL LIABILITY DAAGE TO RENTED PREM MISES Ea occurrence 5 50,000 A CLAIMS-MADE WOCCUR PP1404373 9/6/2015 9/6/2016 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLTS PER: PRODUCTS-COMPMP AGG $ 2,000,000 X POLICY PECT El RO LOC 5 AUTOMOBILE LIABILITY Oa BINE Dt SINGLE LIMIT ES 1,000,000 BANY AUTO BODILY INJURY(Per person) 5 ALL AUTOS NED SCHEDX AUTOS BODILY CNGCV /1/2015 /1/2016 BODILY INJURY(Per accident) S HIRED AUTOS X AUTOSWNED PROPERTY DAMAGE AUTOS Per accidentIx $ S UMBRELLA UAB OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE 5 DEO I I RETENTIONS S C WORKERS COMPENSATION X WC STATU- OTH AND EMPLOYERS'LIABILITY YIN ANY PROMEMBFR1PARTNERlEXECUTIVE� N f A E.L EACH ACCIDENT S 100,000 OFEICERlMEMBER:J(CLURER� (Mandatory in NH) E.L.-DISEASE-EA EMPLOYEQ S 100,000 It yes,describe under DESCRIPTION OF OPERATIONS belim FC003989723 9/23/2015 9/23/2016 EL DISEASE-POUCY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Roma"Schedule,if more space is remained) ROOFING & SIDING INSTALLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING INSPECTOR 1600 OSGOOD STREET AUTHORIZEDAUTHORIZEDREPRESENTATIVE NORTH ANDOVER, MA 01845 John Koegel/KH3 _ ACORD 25(2010/05) (D1988-2010 ACORD CORPORATION. All rights reserved. INS026(7niwon+ Tho ARr)Rr)nomas�nr1 Innn ora ranlaforari mar4e of Ar nizin o���l�c3spe'ac/r%anit License or registration valid for individul use only before the eypiration date. If found return to: Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR TyOff-lee of Consumer Affairs and Business Regulation registration: '104569 10 Park Plaza-Suite 5170 xpiration 7!14!2016.<, Private Cofporatic l Boston,MA 02116 DAVID CASTRICONE ROOFING,SIDING& David Castricone 23.1 R SUTTON ST SUITE 3A Not valid without signature NORTH ANDOVER,NIA 01845 Undersecretary Massachusetts Department of.Public Safety 4, ,= Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRICONE. 31 COURT STREET NORTH ANDOVER MA 0,1845 {, CA � Expiration: Coi�nmissioner 12116I2017 Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CSSL-099358 Construction Supervisor Specialty DAVID T CASTRIC ONE 31 COURT STREET 13- NORTH ANDOVER MA 01845 &,-- Expiration; Commissioner 1211S/2017 %�r' �rm qrr rrrrYvi�/�r/'���irJ,rrr�rrir/�; Office of Consumer.affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: Re two ,. 9 104569 Type: Expiration: 7/14/2018 Private Corporation DAVID CASTRICONE ROOFING,S€D#NG& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary